Septic shock in bacteremic patients: Risk factors, features and prognosis
Septic shock in bacteremic patients: Risk factors, features and prognosis
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DOI：
10.3109/00365549709008668
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发表时间：
1997-01-01
影响因子：
--
通讯作者：
Pitlik, SD
中科院分区：
文献类型：
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作者：
Leibovici, L;Drucker, M;Pitlik, SD
在3，631例患者中检测到的4，289次菌血症发作中，453次（10.5%）诊断为感染性休克。在56%的休克事件中，脓毒性休克发生在首次阳性血培养后24小时以上。在逻辑回归分析中，预测感染性休克的变量为：高龄[1年递增的比值比（OR）为1.015];肾衰竭为基础疾病（OR = 1.47）;中性粒细胞减少症（OR为2.26）;功能受限（增加1个类别的OR为1.54）;未知感染源（OR = 1.66）;厌氧（OR = 2.86）、多种微生物菌血症（OR = 1.54）或除草绿色链球菌以外的病原体（草绿色链球菌OR = 0.08）。与感染性休克相关的住院死亡率为80%，而无休克的菌血症为21%，休克占所有死亡的31%。给予适当经验性抗生素治疗的休克患者的病死率为74.9%，而给予不适当治疗的患者的病死率为84.7%（p = 0.01）。根据目前的结果判断，宿主因素是比病原体类型更重要的决定因素。即使在休克患者中，适当的经验性抗生素治疗也与生存率的提高有关。
Of 4,289 episodes of bacteremia detected in 3,631 patients, septic shock was diagnosed in 453 episodes (10.5%). In 56% of shock episodes, septic shock developed more than 24 h after the first positive blood culture was taken. In a logistic regression analysis, variables predictive of septic shock were: advanced age [odds ratio (OR) of 1.015 for an increment of 1 year]; renal failure as an underlying disorder (OR = 1.47); neutropenia (OR of 2.26); curtailed functional capacity (OR of 1.54 for an increment of 1 category); unknown source of infection (OR = 1.66); anaerobic (OR = 2.86), polymicrobial bacteremia (OR = 1.54), or pathogens other than Streptococcus viridans (OR = 0.08 for Streptococcus viridans). The in-hospital mortality associated with septic shock was 80% vs 21% in episodes of bacteremia without shock, and shock episodes accounted for 31% of all deaths. The fatality rate in shock patients given appropriate empiric antibiotic treatment was 74.9% vs 84.7% in patients given inappropriate treatment (p = 0.01). Judging by the present results, host factors are more important determinants for development of septic shock in bacteremic patients than the type of pathogen. Even in patients with shock, appropriate empiric antibiotic treatment was associated with an improved chance of survival.